Improving Treatment Outcome for Cervical Cancer Using 2-Point Assessment of Quality of Life Among Nigerian Women: A Protocol for a Multi-Center Study.

Background: Cervical cancer is the fourth most common cancer among women globally, with quality of life (QOL) being a major concern for patients with cervical cancer, especially in low- and middle-income countries (LMICs). This is largely due to the advanced nature of the disease at presentation. Although there are a higher number of studies focusing on the QOL of high-income countries, the QOL of cervical cancer patients in LMICs is not available. The aim of this study is to evaluate QOL among women with cervical cancer in Nigeria using a 2-point assessment. Methods: A multi-center prospective cohort study will be conducted in 6 tertiary health facilities randomly selected from the 6 geopolitical zones of Nigeria and consisting of a 2-point assessment of the QOL of participants at the time of diagnosis of cervical cancer and after treatment. Women who were recently diagnosed with histologically confirmed cervical cancer (treatment naïve) will be included. QOL will be assessed using Quality of Life Questionnaire domains (EORTC QLQ30) as developed by the European Organization for Research and Treatment of Cancer (EORTC). In addition to the QOL assessment, relevant and clinicopathological variables will be obtained using a self-structured data extraction sheet designed for this study. All data will be anonymized and will be analyzed using SPSS version 25. Levels of QOL will be calculated using EORTC QLQ30. Ethical approval was obtained from National Health Research Ethics Committee (NHREC/01/01/2007-08/11/2021). Discussion: In view of the paucity of data on QOL in LMICs like Nigeria, where most women with cervical cancer present with advanced disease, this research was designed to help in formulating evidence-based interventions to improve the QOL and treatment outcomes provided to women with cervical cancer in Nigeria and other LMICs. The study is expected to fill these knowledge gaps.

Prevalence and factors associated with disrespect and abuse among women who delivered in a University Teaching Hospital in Nigeria.

OBJECTIVE: To determine the prevalence and factors associated with disrespect and abuse during childbirth among women who delivered in a University Teaching Hospital using a validated tool. METHODS: This was a cross-sectional study conducted at the Department of Obstetrics and Gynecology, University of Benin Teaching Hospital. Participants included women who presented for the 6-week postnatal visit. The primary outcome was the experience of disrespect and abuse by the women in any of the thematic domains in the tool, namely friendly care, abuse-free care, timely care, discrimination-free care, abandonment, and non-consented care. RESULTS: In all, 200 participants were enrolled in the study. The prevalence of disrespect and abuse among the study population was 36.5%. Verbal abuse and untimely care were the commonest (15.5%). Nurses were mostly the perpetrators of disrespect and abuse. Maternal age, parity, and marital status among others were not significantly predictive of disrespect and abuse by respondents. CONCLUSION: Disrespect and abuse from health workers during childbirth is a prevalent problem among women who delivered in the hospital. This undesirable experience of childbirth needs to be addressed by stakeholders in maternal health.

An Assessment of Ovarian Cancer Histotypes Across the African Diaspora.

OBJECTIVE: Ovarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. METHODS: Patients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at p<0.05. RESULTS: Nigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7± 12.8 years) relative to USB (58.9 ± 15.0) and CBB (59.0± 13.0,p<0.001). Black women [CBB (25.2 ± 15.0), Nigerians (29.5 ± 15.1), and USB (33.9 ± 17.9)] were diagnosed with GCT younger than White women (35.4 ± 20.5, p=0.011). Black women [Nigerians (47.5 ± 15.9), USB (50.9 ± 18.3) and CBB (50.9 ± 18.3)] were also diagnosed with SCST younger than White women (55.6 ± 16.5, p<0.01). CONCLUSION: There is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation.

Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria.

BACKGROUND: The highest risk of maternal and perinatal deaths occurs during and shortly after childbirth and is preventable if functional referral systems enable women to reach appropriate health services when obstetric complications occur. Rising numbers of deliveries in health facilities, including in high mortality settings like Nigeria, require formalised coordination across the health system to ensure that women and newborns get to the right level of care, at the right time. This study describes and critically assesses the extent to which referral and its components can be captured using three different data sources from Nigeria, examining issues of data quality, validity, and usefulness for improving and monitoring obstetric care systems. METHODS: The study included three data sources on referral for childbirth care in Nigeria: a nationally representative household survey, patient records from multiple facilities in a state, and patient records from the apex referral facility in a city. We conducted descriptive analyses of the extent to which referral status and components were captured across the three sources. We also iteratively developed a visual conceptual framework to guide our critical comparative analysis. RESULTS: We found large differences in the proportion of women referred, and this reflected the different denominators and timings of the referral in each data source. Between 16 and 34% of referrals in the three sources originated in government hospitals, and lateral referrals (origin and destination facility of the same level) were observed in all three data sources. We found large gaps in the coverage of key components of referral as well as data gaps where this information was not routinely captured in facility-based sources. CONCLUSIONS: Our analyses illustrated different perspectives from the national- to facility-level in the capture of the extent and components of obstetric referral. By triangulating across multiple data sources, we revealed the strengths and gaps within each approach in building a more complete picture of obstetric referral. We see our visual framework as assisting further research efforts to ensure all referral pathways are captured in order to better monitor and improve referral systems for women and newborns.

Clinical characteristics and outcomes for pregnant women diagnosed with COVID-19 disease at the University of Benin Teaching Hospital, Benin City, Nigeria.

INTRODUCTION: the novel coronavirus disease (COVID-19) pandemic has challenged health systems around the world. This study was designed to describe the socio-demographic characteristics of pregnant women with COVID-19 infection, the common clinical features at presentation and the pregnancy outcome at the University of Benin Teaching Hospital, Edo State, Nigeria. METHODS: a cross-sectional analytical study of all confirmed cases of COVID-19 infection from April to September 2020. RESULTS: out of 69 suspected cases that were tested, 19 (28.4%) were confirmed with COVID-19 infection. The common presenting complaints were fever (68.4 %), cough (57.9 %), sore throat (31.6%), malaise (42.1%), loss of taste (26.3%), anosmia (21.1%), and difficulty with breathing (10.6%). In terms of treatment outcome, 57.9% delivered while 36.8% recovered with pregnancy on-going, and 1 (5.3%) maternal death. Of the 11 women who delivered, 45.4% had vaginal deliveries and 54.6 % had Caesarean section. The mean birth weight was 3.1kg and most of the neonates (81.8%) had normal Apgar scores at birth. There was 1 perinatal death from prematurity, birth asphyxia, and intrauterine growth restriction. The commonest diagnosed co-morbidity of pregnancy was preeclampsia and it was significantly associated with severe COVID-19 disease requiring oxygen supplementation (P = 0.028). CONCLUSION: the clinical symptoms of COVID-19 in pregnancy are similar to those described in the non-pregnant population. It did not seem to worsen the maternal or foetal pregnancy outcome. The occurrence of preeclampsia is significantly associated with severe COVID-19 infection requiring respiratory support.

Sickle cell anaemia in vaso-occlusive crisis and acute fatty liver of pregnancy: a case report.

Acute fatty liver of pregnancy (AFLP) is an uncommon condition that manifests in the third trimester of pregnancy. Its association with vaso-occlusive crisis from Sickle Cell Anaemia is not common. Published data on the simultaneous occurrence of these two conditions is rare, hence this case report. A 32-year-old gravida 3 para 1+1 lady, with Sickle Cell Anaemia, had a vaso-occlusive crisis in association with AFLP at 32 weeks' gestation, and the outcome of her management was successful. AFLP is a rare late-gestational event affecting about 1 in 10,000 to 15,000 pregnancies. The exact aetiology is not known. Profound hypoglycaemia and jaundice with elevated serum transaminases are recognized features of AFLP. These features may also be seen in haemoglobinopathies. The simultaneous occurrence of AFLP and Sickle Cell Anaemia may result in overlap of symptoms and delay in diagnosis and treatment. Therefore, maintaining a high index of suspicion is key. The cornerstone for treatment remains prompt delivery and supportive care. AFLP can coexist with Sickle cell crises. It is important that care providers, especially in populations with high burden of Sickle Cell Anaemia, consider this as a differential diagnosis, especially when the jaundice is associated with profound or recurring episodes of hypoglycaemia. Prompt diagnosis and delivery in a multidisciplinary approach is important to avoid adverse maternal and foetal outcomes. FUNDING: No funding sources.

Awareness and uptake of human papilloma virus vaccines among female secondary school students in Benin City, Nigeria.

BACKGROUND: There is no Government endorsed HPV vaccine immunisation program in Nigeria. The Vaccine has been available at the University of Benin Teaching Hospital (UBTH) in Benin City for more than 7 years. OBJECTIVES: The aim was to evaluate awareness about HPV, the prevalence of HPV immunisation and its associated factors among the study population. METHODS: A cross-sectional study using interviewer-administered questionnaires among 215 females attending secondary schools in Benin city, Nigeria. Participants were selected using multi-stage stratified sampling. The primary outcome measure was HPV immunisation of the girls. RESULTS: The majority of the participants were between 14 to 18 years (58.6%). Almost all the participants (>97%) had not heard of HPV, HPV Vaccines and Cervical cancer. In addition, 2 (0.9%) persons correctly identified that the virus can be transmitted sexually while only 1 person (0.5%) had received the HPV vaccine. The respondents all agreed that they needed to be enlightened about HPV, HPV vaccines and Cervical cancer. Majority (49.3%) of the girls suggested that this could be done through the mass media (49.3%) or their parents (32.1%). CONCLUSION: HPV immunisation, knowledge of HPV vaccines and Cervical cancer among the study population was very low. We recommend interventions in Schools to increase knowledge about cervical cancer and HPV vaccines.

A twenty year experience with the use of intrauterine contraceptive device (IUCD) in a university teaching hospital in South- south Nigeria

Context: Contraceptive prevalence in Nigeria is low at 17%. Amongst Nigerian women and couples who accept to use contraception, the IUCD is the most commonly used contraceptive method with variation in rates of use between geographical areas and among Health Institutions. Factors that determine decision making on IUCD use are not well understood. Aims: To study the use, effectiveness, complications and discontinuation rates for intrauterine contraceptive device received at the University of Benin Teaching Hospital from 1997 to 2016 and analyzed in January, 2019. Study Design: This was a retrospective cross sectional study. Methodology: The case notes of all 3326 new clients who accepted Copper T intrauterine contraceptive device at the UBTH Family Planning Clinic during the review period were retrieved and analyzed. Data regarding acceptors socio-demographic characteristics, side effects, effectiveness, complications, duration of use and reasons for discontinuation were extracted and entered into SPSS for windows version 22.0 and analyzed. Results: Out of the 8203 clients that accepted to commence a family planning method, 3326 (40.55%) accepted to use IUCD. The mean age of IUCD acceptors at commencement was 33.4±5.60 and the mean age of their husbands was 39.85±6.91. The mean parity was 3.73±1.87 (range 0-12), while the mean number of living children was 3.56±1.66 (range 0-10). The mean duration of use (in months) was 40.43±40.13. Women with 5 or more children (P Value 0.000) and at least a minimum of secondary education (P Value 0.000), were significantly associated with IUCD use duration of > or more than 2 years. Also, women who reported satisfaction with IUCD (P Value 0.000) and no complications (P Value 0.000) were also associated with longer duration of use. Conclusion: IUCD is a common family planning method used by women at UBTH. Its duration of use is higher among clients with more children, at least a minimum of secondary school education and no complications from its use. This information is relevant for family planning service providers to increase contraceptive uptake by women in Nigeria

The Relationship between the Serum Level of Selenium and Cervical Intraepithelial Neoplasia: A Comparative Study in a Population of Nigerian Women

Objective: To determine the relationship between the serum level of selenium and cervical intraepithelial neoplasia (CIN). Methods: A case controlled study that compared the serum level of selenium in 45 women with CIN (cases) to 45 women (age matched controls) with normal cervical cytology. Socio-demographic data and information on known risk factors for cervical cancer among the sample was compared between both groups using inferential statistics. Results: There was no significant difference in the mean selenium values between the cases and controls [p- 0.076, 95% CI (-15.08 ­ 0.76)]. However, subgroup analysis showed a statistically significant difference between patients with normal cervical cytology, CIN I, II and III (p= 0.021). In addition, there was also significant difference in the selenium level between women with normal cervical cytology and CIN III (p value = 0.016) with a significant inverse linear trend (p= 0.025). Conclusion: With increasing severity of CIN, a significant reduction in the level of selenium in serum was observed. This reducing value of serum selenium, a surrogate marker for increased oxidative stress, may be important factor for the development of persistent HPV infection and in particular high grade CIN III lesions. This observation requires further research.

Human papilloma virus vaccine: determinants of acceptability by mothers for adolescents in Nigeria.

Vaccination of adolescent females against Human Papilloma Virus (HPV), the causative agent for cervical cancer has recently become available. As minors, parental acceptance of the vaccines for adolescent daughters requires exploration. This was a cross-sectional survey of 201 mothers attending the gynaecology clinic in a University Teaching Hospital in Nigeria on acceptability of the HPV vaccines and its determinants. Although 70% accepted vaccination of their daughters, 30% were unwilling and the commonest reason for unwillingness was that it may encourage sexual promiscuity (62.3%). Mothers with poor knowledge of STI were significantly more unwilling to accept HPV vaccines compared to those with average or good knowledge (p = 0.002). Furthermore, perception of susceptibility to HPV infection by daughters was significantly associated with acceptance of the vaccines (p = 0.0001). Increased advocacy and public enlightenment on cervical cancer control and the role of HPV vaccines in its prevention is still necessary especially in developing countries.

Women's concerns and satisfaction with induced labour at term in a Nigerian population.

AIMS AND OBJECTIVES: To explore the concerns, experiences and satisfaction of women who had induction of labour at term MATERIALS AND METHODS: A cross-sectional study conducted in Nigeria, among 252 pregnant women who had induction of labour at term using a two part pre and post induction questionnaire. RESULTS: Concerns expressed by the women prior to labour induction were the fear of caesarean delivery (16.6%), labour pains (15.1%) and an adverse foetal or maternal outcome (4.8%). Overall, 180 women (71.4%) expressed satisfaction with the induction process while 72 (28.6%) were dissatisfied. Comparatively, a higher mean age and shorter induction-delivery interval (470±180 vs 660±370, p<0.001) was significantly associated with maternal satisfaction with induced labour. It was also associated with significantly lower caesarean section rates (13.3% vs 61.1%, p=0.001) and composite maternal or foetal morbidities. The common reasons for dissatisfaction with induced labour included caesarean delivery (13.4%), painful labour (8.7%) while 2.4% felt the duration of the procedure was too long. CONCLUSION: This study suggests that a substantial number of pregnant women who had induction of labour had unsatisfactory experience. The reasons for dissatisfaction should be addressed by physicians in order to promote a positive psycho-emotional experience of pregnancy and childbirth.

Stillbirth in cases of severe acute maternal morbidity.

OBJECTIVE: To determine the incidence and correlates of stillbirths among women with severe acute maternal morbidity (SAMM). METHODS: In an observational study of 728 women who had SAMM between January 2007 and December 2010 at a referral tertiary health facility in Benin, Nigeria, the incidence of stillbirth, and the clinical and demographic correlates of stillbirth were evaluated. RESULTS: The rate of stillbirth among women with SAMM was 210 per 1000 deliveries. The rate among women who had uterine rupture (643 per 1000 deliveries) far exceeded other cause-specific rates of stillbirth. Unbooked status (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.3-3.8), low maternal education (OR, 2.1; 95% CI, 1.2-4.0), vaginal delivery (OR, 8.1; 95% CI, 5.1-13.0), and maternal comorbidity (OR, 12.9; 95% CI, 6.2-26.9) were factors associated with stillbirth after adjusting for confounding variables. CONCLUSION: In Nigeria, SAMM was found to be associated with an unacceptably high rate of stillbirth. Strategies to improve fetal surveillance among women with SAMM are necessary to address the excessively high incidence of stillbirth among these patients.

An audit of maternal deaths from a referral university teaching hospital in Nigeria: the emergence of HIV/AIDS as a leading cause.

AIMS AND OBJECTIVES: To analyse the characteristics and causes of maternal death in a referral tertiary health facility in Southern Nigeria. MATERIALS AND METHODS: This is a facility- based review of 184 maternal deaths that occurred from January 2005 to June 2009. Primary causes of death and factors that contributed to maternal death including delay in accessing health care were identified. RESULTS: During the study period, the Maternal Mortality Ratio (MMR) was 2230/100,000 live births. There was a progressive reduction in the annual MMR from 2901/100,000 live birth in 2005 to 1459/100,000 live birth in 2009. More than four fifth (84.9%) of the maternal deaths occurred among women of low socio-economic class (IV and V). The leading causes of direct maternal deaths (64.1%) were Puerperal sepsis (17.8%), Pre-eclampsia/Eclampsia (15.8%) and complications of unsafe abortion (11.4%). HIV/AIDS was the third commonest overall cause of maternal death (15.2%). Half of the women experienced Type 1 delay (50%), Type 2 and 3 delay occurred in 7.6% and 18.5% of maternal deaths respectively. About two thirds of the women (58.2%) experienced more than one form of delay. CONCLUSION: Although direct obstetric deaths remain the leading cause of maternal mortality, HIV/AIDS is becoming an important primary cause of maternal mortality in our environment. Organization of health service delivery with an effective referral system and the provision of optimal care for HIV infected women are recommended.

Pregnancy outcome following induction of labor with intravaginal misoprostol for decreased fetal movements at term.

OBJECTIVE: To determine the outcome of labor induction with intravaginal misoprostol among women with perception of persistent decrease in fetal movements at term. METHOD: The study group comprising 107 women who had induction of labor at term for primary complaint of decreased fetal movements (DFM) were compared with equal number of women who had induction for prolong pregnancy in a university teaching hospital. RESULTS: Caesarean section rate (39.3% vs. 22.4%, P < 0.001) and birthweight less than 2500 g (11.2% vs. 2.8%, P = 0.02) were significantly higher in the DFM group with the leading indication for caesarean delivery being nonreassuring fetal heart rate. Also, the incidence of 5-min Apgar score <7 were significantly lower among women in the DFM group. However, there was no difference in neonatal unit admission. There was no case of early neonatal death in both groups of women. CONCLUSION: Intravaginal misoprostol for labor induction is a safe delivery option for women with perception of DFM with reassuring nonstress test. Since all cases with persistent decrease in fetal movements had reassuring nonstress test, the reduction in fetal movements was most likely due to altered perception.

Perception and attitude of women with previous caesarean section towards repeat caesarean delivery.

OBJECTIVE: To explore the perception and attitude of women with previous caesarean section towards repeat caesarean section. METHOD: Observational study of women with prior caesarean delivery using an anonymous semi-structured questionnaire. Information elicited include the socio-demographic characteristics, outcome of the last caesarean delivery, experience of complications or domestic violence, acceptance of repeat caesarean section if advised by the doctor and the reason for any refusal. RESULTS: One hundred thirty-nine parturients participated in the study. Seventy-seven percent had 1 previous caesarean delivery while 24.46% will decline a repeat caesarean section. Major reasons for refusal were postoperative pain, cultural aversion, fear of death, and cost of caesarean delivery. The rate of acceptance was significantly higher amongst those with more than one prior caesarean section while the rate of refusal was significantly higher amongst those who experienced perinatal death in the last caesarean delivery. Twelve percent experienced domestic violence (almost entirely psychological) mainly from the spouse or his relatives. CONCLUSION: A significant proportion of women with previous caesarean delivery will decline a repeat caesarean section if medically indicated. There is need for bahavior change communication involving the community, improved postoperative pain management, and better counseling especially on safety of the procedure.

Prevalence and correlates of intimate partner violence against HIV-seropositive pregnant women in a Nigerian population.

OBJECTIVE: To evaluate the prevalence and correlates of intimate partner violence among HIV-positive pregnant Nigerian women. DESIGN: Cross-sectional study using an anonymous semi-structured interviewer-administered questionnaire. SETTING: The antenatal clinic at the University of Benin Teaching Hospital, Nigeria, from June 2008 to December 2009. POPULATION: 305 HIV-positive women receiving antenatal care. METHODS: An anonymous semi-structured World Health Organization modified questionnaire that elicited information on the experiences of intimate partner violence, was administered to the women by trained female interviewers. MAIN OUTCOME MEASURES: Prevalence, pattern and risk factors associated with experiencing intimate partner violence. RESULTS: The prevalence of intimate partner violence among the women was 32.5%, with psychological violence being the most common form of violence reported (27.5%) and physical violence the least reported (5.9%). Identified risk factors for experiencing violence were multiparity (Odds ratio 9.4; CI 1.23-71.33), respondents with an HIV-positive child (Odds ratio 9.2; CI 4.53-18.84), experience of violence before they were diagnosed HIV-positive (Odds ratio 44.4; 10.33-190.42) and women with partners without post-secondary education (Odds ratio 2.3; CI 1.40-3.91). CONCLUSION: Intimate partner violence is a prevalent public health problem among HIV-infected pregnant women in our community and it may hinder efforts to scale up prevention of mother-child transmission programs, especially in developing countries. Screening for intimate partner violence to identify abused women should be incorporated into these programs to offer these women optimal care.

Morbidity associated with failed vaginal birth after cesarean section.

We investigated morbidity and factors associated with failed vaginal birth after cesarean delivery (VBAC). In a retrospective cohort study maternal and neonatal outcomes of women who underwent VBAC in three Nigerian University Teaching Hospitals were reviewed. Univariate, followed by multivariate analyses, were conducted. VBAC was successful in 683 of 1,013 women (67.4%), whereas 330 (32.6%) had failed VBAC. Failed VBAC was associated with higher incidence of chorioamnionitis, postpartum hemorrhage, blood transfusion, uterine rupture, hysterectomy, and composite major neonatal morbidities. Younger age, lack of previous vaginal delivery, induction of labor and fetal weight >4,000 g were risk factors for failed VBAC. A majority of women who try VBAC achieve a vaginal delivery. Failed VBAC is associated with increased maternal and neonatal morbidity and is somewhat predictable.

Trends and determinants of pregnancy-related domestic violence in a referral center in southern Nigeria.

OBJECTIVE: To describe the trend and identify associated risk factors for pregnancy-related domestic violence. METHODS: In a cross-sectional study of 502 women attending the sixth week postnatal clinic in a tertiary hospital in urban Nigeria, participants completed semi-structured questionnaires on experience of domestic violence before and during pregnancy, and in the puerperium. Multivariate logistic regression was used to assess risk factors associated with experiencing violence. RESULTS: The prevalence of domestic violence was 43.5% during the 12 months before the pregnancy, 28.3% during the pregnancy, and 4% in the puerperium. Psychological violence was the commonest form of violence experienced. All forms of violence were least common in the puerperium. Experience of violence in the 12 months before pregnancy (P<0.0001, odds ratio 274.34 [95% CI, 66.4-1133.8]), HIV seropositivity (P=0.02, odds ratio 2.81 [95% CI, 1.2-6.5]), and regular alcohol intake (P<0.0001, odds ratio 11.60 [95% CI, 3.8-35.1]) significantly increased the likelihood of experiencing domestic violence. CONCLUSION: Pregnancy-related domestic violence is an important health problem in this community in southern Nigeria. Experience of violence before the pregnancy, HIV infection, and regular alcohol consumption are risk factors.

Social induction of labour: experience in an urban teaching hospital in Nigeria.

PURPOSE: To document the experience with social induction of labour (IOL) and compare its outcome with electively induced labour for prolonged pregnancy. METHODS: A prospective matched case-control study. RESULT: Social IOL was significantly common in women of high social class (78.3 vs. 45.6%, P = 0.03) and the commonest indication was because the parturient was 'tired of pregnancy' (60.9%). There was no significant difference between both groups in the mean induction to delivery interval, caesarean section and instrumental delivery rates, 5-minute Apgar score <7 and early neonatal death. CONCLUSION: Social IOL in well-selected cases has comparable outcomes to elective IOL for prolonged pregnancy. There is still the need for evaluating the determinants of maternal request for social IOL and the development of guidelines to regulate its practice.